What was the black death and where did it spread?

Introduction

Medieval people called the catastrophe of the 14th century either the "Great Pestilence"' or the "Great Plague." Writers contemporary to the plague referred to the event as the "Great Mortality." Swedish and Danish chronicles of the 16th century described the events as "black" for the first time, likely to refer to black as glum or dreadful denoting the terror of the events. The German physician Justus Hecker suggested that a mistranslation of the Latin atra mors (terrible, or black, death) had occurred in Scandinavia when he described "The Black Death in the 14th century." Black Death became more widely used in the German- and English-speaking worlds.

The Death Toll

In October 1347, a ship came from the Crimea and Asia and docked in Messina, Sicily. Aboard the ship were not only sailors but rats. The rats brought with them the Black Death, the bubonic plague. Reports that came to Europe about the disease indicated that 20 million people had died in Asia. Knowing what happened in Europe, this was probably an underestimate, because there were more people in Asia than Europe. Best estimates now are that at least 25 million people died in Europe from 1347 to 1352. This was almost 40% of the population (some estimates indicate 60%). Half of Paris's population of 100,000 people died. In Italy, Florence's population was reduced from 120,000 inhabitants in 1338 to 50,000 in 1351. The plague was a disaster practically unequalled in the annals of recorded history and it took 150 years for Europe’s population to recover.

The Plague Doctor Costume

The plague doctor costume consisted of an ankle length overcoat, a bird-like beak mask filled with sweet or strong smelling substances, along with gloves and boots. The mask had glass openings for the eyes. Straps held the beak in front of the doctor's nose which had two small nose holes and was a type of respirator. The beak could hold dried flowers (e.g roses or carnations), herbs (e.g. mint), spices, camphor or a vinegar sponge. The purpose of the mask was to remove bad smells, thought to be the principal cause of the disease. Doctors believed the herbs would counter the "evil" smells of the plague and prevent them from becoming infected. The costume included a wide brimmed leather hat to indicate their profession. They used wooden canes to point out areas needing attention and to examine patients without touching them. The canes were also used to keep people away and to remove clothing from plague victims without having to touch them.

Three Forms of the Plague

Three forms of the plague brought an array of signs and symptoms to those infected:

• Bubonic plague refers to the painful lymph node swellings called buboes, primarily found around the base of the neck, in the armpits and groin which oozed pus and bled. Victims underwent damage to the skin and underlying tissue until they were covered in dark blotches. Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land. The bubonic plague was the most commonly seen form during the Black Death, with a mortality rate of 30-75% and symptoms including fever of 38 - 41 °C (101-105 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Of those who contracted the bubonic plague, 4 out of 5 died within eight days.
• The pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. Pneumonic plague was the second most commonly seen form during the Black Death with a mortality rate of ninety to ninety-five percent.
• The septicaemic plague is a form of deadly blood poisoning. The disease is contracted primarily through the bite of an infected insect. Septicemic plague can cause disseminated intravascular coagulation, and is almost always fatal; the mortality rate in medieval times was 99-100 percent. Septicemic plague is the rarest of the three plague varieties.

Rats

The bubonic plague mechanism was dependent on two populations of rodents: one resistant to the disease, which acts as hosts, keeping the disease endemic; and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic. The original carrier for the plague-infected fleas thought to be responsible for the Black Death was the black rat. The bacterium responsible for the Black Death, Yersinia pestis, was commonly endemic in only a few rodent species and is usually transmitted zoonotically by the rat flea. Brown rats may suffer from plague, as can many non-rodent species, including dogs, cats, and humans.

The Nuremberg Chronicle

The burning of Jews in the 14th century during the black death (bubonic plague). Jews were perceived as being less susceptible to the plague than their neighbours (likely the result of Jewish ritual regarding personal hygiene) and they were accused of poisoning Christian wells: thought to be the source of the plague.

Page CCXXX, English Translation:

"The miserable wretched Jews, in A.D. 1337, at Deckendorf, on the Danube, in Bavaria, in scorn and ignominy of the divine majesty and high veneration paid to our Lord Jesus Christ and to the holy Christian religion, stabbed the Holy Sacrament many times. They then threw it into a hot oven, and as it remained unconsumed, they finally placed it on an anvil and struck it with hammers. When this became known, the Jews were seized by Hartmann von Degenberg, the caretaker, and the citizens; and when the truth was established, they were deservedly condemned to death. And this same Host, being present at the Holy Sepulchre, is venerated for its many miracles.

Thereafter, in the year A.D. 1348, all the Jews in Germany were burned, having been accused of poisoning the wells, as many of them confessed.

At this time locusts and vermin passed through the sky from east to west like a thick cloud, devastating all vegetation and fruits; and after they were dispersed the stench caused a horrible pestilence.

A pitiful and lamentable pestilence began in the year 1348 and endured for three years throughout the world. It resulted from the aforesaid locusts or vermin. It started in India and spread as far as England, ravaging Italy and France, and finally Germany and Hungary. The mortality was so rapid and great that barely ten persons out of every thousand survived. In some regions only about one third of the population escaped. Many cities, towns, marts and villages died out entirely and remained void. Some said that the Jews increased this calamity by poisoning the wells."

Page CCLXIIII, English Translation:

"Nothing is better than death, nothing is worse than an unjust life. Death, the best for men, the everlasting rest from labors, You loosen the yoke of old age by the will of God, You remove the heavy chains from the neck of those held captive, And you take away exile. You break open prison doors. You snatch away the unworthy, making possessions equal in fair portions, And you remain unmoved, incapable of being persuaded by any means. Set in place since the first day, you order the soul to Bear all things serenely with the promise of an end to labors.

Without you life is torment and an everlasting prison."

Treatment

Some medieval cures and preventive measures for the plague:

• Plague is a scourge from God for your evil deeds—by scourging yourself with a whip like a flagellant, then God has no reason for scourging you with plague.
• Apply a mixture of tree resin, roots of white lilies and human excrements.
• Bathing should not be avoided, and be done with vinegar and rosewater—alternatively in your own urine.
• Drink the pus of lanced buboes.
• Quarantine people for 40 days (quarantine comes from latin for 40)—first done in Venice in 1348.
• Place a live hen close to the swellings to draw out the pestilence then drink a glass of your own urine twice a day.
• Grind up an emerald and drink it in wine.
• Injest snakeskin, bone from the heart of a stag, Armenian clay, precious metals, aloe, myrrh and saffron.
• Roast the shells of newly laid eggs, and grind them to a powder—add Marigold flowers and treacle—drink in warm beer every morning and night.

©2017 John Martin Rare Book Room, Hardin Library for the Health Sciences, 600 Newton Road, Iowa City, IA 52242-1098 Image: Pieter Bruegel, The Triumph of Death (detail), c. 1562, oil on panel, 117 x 162 cm, Museo del Prado, Madrid   Acknowledgements to Alice M. Phillips for her work editing the original exhibit material and subsequent web design.

The medieval Silk Road brought a wealth of goods, spices, and new ideas from China and Central Asia to Europe. In 1346, the trade also likely carried the deadly bubonic plague that killed as many as half of all Europeans within 7 years, in what is known as the Black Death. Later outbreaks in Europe were thought to have arrived from the east via a similar route. Now, scientists have evidence that a virulent strain of the Black Death bacterium lurked for centuries in Europe while also working its way back to Asia, with terrifying consequences.

At the Society for American Archaeology meetings earlier this month in Orlando, Florida, researchers reported analyzing the remains of medieval victims in London; Barcelona, Spain; and Bolgar, a city along the Volga River in Russia. They determined that the victims all died of a highly similar strain of Yersinia pestis, the plague bacterium, which mutated in Europe and then traveled eastward in the decade following the Black Death. The findings "are like pearls on a chain" that begins in western Europe, said Johannes Krause at the Max Planck Institute for the Science of Human History in Jena, Germany, an author of a soon-to-be-published study. (The lead author is Maria Spyrou, also at Jena.)

That chain may have stretched far beyond Russia. Krause argues that a descendant of the 14th century plague bacterium was the source of most of the world's major outbreaks, including those that raged across East Asia in the 19th and 20th centuries and one afflicting Madagascar today. Eric Klingelhofer, an emeritus archaeologist at Mercer University in Macon, Georgia, called Krause's presentation "a good piece of research." But molecular microbiologist Holger Scholz at Munich, Germany's Bundeswehr Institute of Microbiology is skeptical. "I just think it's not very likely that a strain from China came to Europe, survived there for a couple of hundred years, and moved back to China," she said. "That sounds pretty adventurous."

Advances in sequencing the DNA of pathogens found in ancient human skeletons are driving new research—and  debate—on the spread of plague. Thanks to a series of recent findings, the notion that plague remained in Europe for centuries after the Black Death, rather than arriving in repeated waves from Asia as historians long assumed, is gaining ground.

A team led by Lisa Seifert at Munich's Ludwig Maximilian University reported in January that the Black Death strain persisted in Europe for at least 3 centuries, based on DNA sequences from eight skeletons at two burial sites in Germany that spanned the 14th to the 17th centuries. The sequences were "highly similar" to those from earlier European victims, according to the study, which included Scholz. While not precluding continued waves of plague coming from Asia, the team concluded that there was "a long-time persistence of the pathogen in a not-yet-identified reservoir"—perhaps rats.

Also in January, a team led by Kirsten Bos at Jena's Max Planck Institute reported further evidence that a descendant of the Black Death strain hung on in Europe, implicating it in the last major European plague outbreak, in Marseille, France. Using DNA from the teeth of five individuals who died in 1722, the group found that the Y. pestis strain in Marseille likely evolved from the Black Death. "Our results suggest that the disease was hiding somewhere in Europe for several hundred years," said Bos, whose team included Krause.

Now, Krause has traced the Black Death's eastward spread. His team studied skeletons from a cemetery near the Tower of London firmly dated to 1348–1350, in the wake of the Black Death, as well as from a Barcelona cemetery radiocarbon-dated to the mid-14th century. The Russian evidence comes from a site that included coins from 1360; the burial is estimated to have taken place between the early 1360s and 1400. DNA sequencing from all three places revealed the same strain of Y. pestis. This strain appears to be the ancestor of the one that killed millions in 19th century China, based on phylogenetic clues.

"If the plague in China was actually European in origin, it's a cruel irony of history," says Klingelhofer, who notes that this was the era when Western powers dominated China. Krause adds that the plague affecting Madagascar as recently as last year also seems genetically related to the variety that spread east from Europe in the 14th century.

Researchers are eager to create a plague family tree in order to understand the movements and impact of different varieties of Y. pestis across time and space. Krause argues that three of the four branches of plague seem to have evolved in Asia. But he says the branch related to the strain that developed in Europe immediately after the Black Death has proved the most mobile and devastating.

Krause admits that between 14th century London and 21st century Madagascar, there are "a lot of steps missing" to identify the precise movements of the deadly bacterium. But he says that understanding plague's long journey could help researchers limit its future spread.